Introduction

In response to dramatic increases in health care costs in the 1980s, the health care systems in many developed countries were restructured in an effort to constrain this growth. Some of these changes in the organizational systems and reimbursement mechanisms for delivering health care, as exemplified by the managed care industry in the United States, have raised concerns that cost-containment strategies may adversely affect the quality of medical care being delivered. To collect objective information on quality, indicators of quality of care must be developed and validated (2). In addition to quality of care, the debate over optimal systems for delivering health care has also focused on questions of ensuring adequate access to care (22) and reducing disparities in the receipt of health care services.

This chapter addresses the conceptualization of quality of care and quality-of-care assessment for status epilepticus (SE). A framework for disseminating and evaluating the impact of established quality-of-care standards for the management of SE is presented, using examples from published research for another condition. Emergency department (ED) visits and hospitalizations for SE can serve as indicators of decreased access to health care, especially if SE is included among the conditions recently conceptualized as ambulatory-sensitive conditions. Additional research is needed to assess the goals of improving quality of care for SE and access to care for this population.